The complete reimbursement picture for your product

Vantage answers the three questions every device company eventually faces. What code does this bill under, which payers will cover it, and what will providers actually be paid? The answer arrives as an interactive landscape covering the coding pathway, Medicare and commercial coverage positions payer by payer, fee schedule economics by site of service, and a strategy section that turns the findings into a sequenced plan.

It is the foundation engagement, and it runs expert-in-the-loop, with a senior market access partner matched to your product at scoping who directs the research and reviews the strategy before it ships. Every other Praxa product builds on the verified ledger a Vantage produces.

What lands in your inbox

Interactive HTML landscape, hosted behind client-only access controls
Executive presentation deck, board-ready
The verified claims ledger, listing every factual claim with source, date, and verification status
Per-payer coverage table with evidence requirements and policy citations
Sequenced recommendations tied to the engagement ladder, priced
Senior market access expert review of the strategy and recommendations
Live walkthrough plus two rounds of revisions, included

Three pillars, examined together

Coding

The pathway and its history

Applicable CPT and HCPCS codes, Category III status and history, comparable code trajectories, and what a Category I path would require. Where coding is ambiguous, the options are laid out with tradeoffs.

Coverage

Payer positions

Medicare positions including MAC-level variation, commercial policies for the payers that matter to your geography and mix, and the specific evidence requirements each policy names.

Payment

The economics per encounter

Fee schedule rates by site of service, facility and professional splits, and where published policy and realized payment diverge, flagged for the claims module to quantify.

A sample of the coverage section

This sample comes from a landscape built for a fictional device, Northwind Medical's Cadence Thermal Probe, billed under Category III code 0X12T. The payers are real, and every position and figure is illustrative. Open a payer to see its position, the next step, and its source in the ledger.

Sample landscape Northwind Medical, Cadence Thermal ProbeCoverage by payer

PayerCoverageClaims paid

Medicare, the four contractors with a rateCovered84%

Position: Novitas JH and JL, WPS J5, and First Coast JN added 0X12T to their fee schedules in January 2026. None has a local coverage determination, so each claim is reviewed on its own.
Next step: Watch the four fee schedules each quarter, since a new local coverage determination could add criteria.
Source: L-0046, the four contractors' fee schedules, January 2026

Medicare, the other eight contractorsNo policy32%

Position: No fee schedule entry, so claims are priced individually and many are denied.
Next step: Pricing requests, starting with Noridian JF and NGS JK, which carry the most claims.
Source: L-0052, fee schedules for all twelve Part B contractors, third quarter 2026

UnitedHealthcareNot covered9%

Position: Its medical policy classifies the procedure as unproven and not medically necessary.
Next step: A reconsideration request built on the pivotal trial results and the Florida Blue payment record.
Source: L-0083, UnitedHealthcare Medical Policy, reviewed 1 March 2026

AetnaNot covered11%

Position: Its policy on tissue ablation lists the procedure as experimental and investigational.
Next step: A reconsideration request after UnitedHealthcare, timed before Aetna's annual review of the policy in December.
Source: L-0091, Aetna Clinical Policy Bulletin, reviewed 30 December 2025

CignaNot covered26%

Position: Its policy lists the procedure as investigational, and the claims it pays come through individual review.
Next step: Compare paid and denied claims by account to find the documentation that gets claims through review.
Source: L-0094, Cigna Medical Coverage Policy, reviewed 15 April 2026

Florida BlueNo policy78%

Position: No written policy, and claims are paid on review at $960 on average.
Next step: Ask for written coverage criteria while the payment record is strong.
Source: L-0124, computed from Florida Blue remittances, with its policy library searched 6 October 2026

Blue Cross Blue Shield of TexasNo policy55%

Position: No written policy, and about half of claims are paid on review.
Next step: The same request as Florida Blue once Texas volume supports it.
Source: L-0127, computed from remittances, with its policy library searched 6 October 2026

Humana Medicare AdvantageConditional26%

Position: Requires prior authorization, then pays at the local Medicare contractor's rate.
Next step: Prior authorization templates for the accounts in the four priced jurisdictions.
Source: L-0131, Humana prior authorization list, October 2026

Claims paid is the share of adjudicated claims paid in the sample claims extract, April 2025 to September 2026.

Asked and answered

Why is this so much cheaper than a traditional landscape assessment?

Traditional firms price the analyst hours; comparable assessments rebuild at $15,000 to $40,000 in senior time over four to twelve weeks. Our pipeline does the research fan-out and drafting, so the price reflects verification and judgment, the parts that need people. The deliverable is deeper than the hourly version. Ask to see a sample ledger.

What do you need from us to start?

Product basics, regulatory status, target sites of service, and any payer intelligence you already hold. The intake is a short checklist; most clients complete it in under an hour.

Does the price change if our product is complicated?

Scope drives the quote inside the published range, based on the number of candidate codes, payer set, and sites of service. The scoping call fixes the number and it does not move afterward.

What happens when the landscape goes stale?

Policies and rates move quarterly, which is exactly why Vantage Live exists. Subscribers get a monthly change memo, alerts when something material moves, and every claim in the ledger re-verified on a quarterly cycle.

Ready to scope it?

Thirty minutes fixes the question, the deliverable, and the price. Kickoff within days of signature.

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